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    Health Information

    Vitamin B3

    Vitamin B3

    Uses

    What Are Star Ratings?

    Our proprietary ?Star-Rating? system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by the medical community, and whether studies have found them to be effective for other people.

    For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.

    3 Stars Reliable and relatively consistent scientific data showing a substantial health benefit.

    2 Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.

    1 Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement,little scientific support.

    This supplement has been used in connection with the following health conditions:

    Used for Why
    3 Stars
    Acne Vulgaris
    Apply 4% gel twice per day
    [3 stars] In a double-blind trial, applying a topical 4% niacinamide gel twice daily for two months significantly improved acne.
    In a double-blind trial, topical application of a 4% niacinamide gel twice daily for two months resulted in significant in improvement in people with acne.1 However, there is little reason to believe this vitamin would have similar actions if taken orally.
    3 Stars
    High Cholesterol
    1,500 to 3,000 mg daily under a doctor's supervision
    High amounts (several grams per day) of niacin, a form of vitamin B3, have been shown to lower cholesterol.

    High amounts (several grams per day) of niacin, a form of vitamin B3 , lower cholesterol, an effect recognized in the approval of niacin as a prescription medication for high cholesterol.2 The other common form of vitamin B3?niacinamide?does not affect cholesterol levels. Some niacin preparations have raised HDL cholesterol better than certain prescription drugs.3 Some cardiologists prescribe 3 grams of niacin per day or even higher amounts for people with high cholesterol levels. At such intakes, acute symptoms (flushing, headache, stomachache) and chronic symptoms (liver damage, diabetes , gastritis , eye damage, possibly gout ) of toxicity may be severe. Many people are not able to continue taking these levels of niacin due to discomfort or danger to their health. Therefore, high intakes of niacin must only be taken under the supervision of a doctor.

    Symptoms caused by niacin supplements, such as flushing, have been reduced with sustained-release (also called ?time-release?) niacin products. However, sustained-release forms of niacin have caused significant liver toxicity and, though rarely, liver failure.4 , 5 , 6 , 7 , 8 One partial time-release (intermediate-release) niacin product has lowered LDL cholesterol and raised HDL cholesterol without flushing, and it also has acted without the liver function abnormalities typically associated with sustained-release niacin formulations.9 However, this form of niacin is available by prescription only.

    3 Stars
    High Triglycerides
    500 mg three times per day
    [3 stars] The niacin form of vitamin B3 is used by some doctors to lower triglycerides, however, the quantity needed to achieve reductions may cause side effects. Ask your doctor is niacin is right for you.

    The niacin form of vitamin B3 is used by doctors to lower cholesterol levels, but niacin also lowers TG levels.10 The amount of niacin needed to achieve worthwhile reductions in cholesterol and TG levels is several grams per day. Such quantities can cause side effects, including potential damage to the liver, and should not be taken without the supervision of a doctor. Some doctors recommend inositol hexaniacinate (a special form of vitamin B3) as an alternative to niacin. A typical amount recommended is 500 mg three times per day.11 , 12 This form of vitamin B3 does not typically cause a skin flush and is said to be safer for the liver than niacin. However, the alleged safety advantage of inositol hexaniacinate needs to be confirmed by additional clinical trials. Moreover, it is not clear whether inositol hexaniacinate is as effective as niacin at lowering cholesterol and TG levels.

    3 Stars
    Intermittent Claudication
    2 grams twice per day
    [3 stars] Inositol hexaniacinate, a special form of vitamin B3, has been used successfully to reduce symptoms, this treatment should be monitored by a doctor.

    Inositol hexaniacinate (IHN), a special form of vitamin B3, has been used successfully to treat intermittent claudication. The alleged advantage of IHN over niacin (another form of vitamin B3) is a lower risk of toxicity. A double-blind trial explored the effect of 2 grams of IHN taken twice per day for three months.13 In nonsmokers and in people with unchanged smoking habits, the increase in walking distance was significantly greater in the IHN group than in the placebo group. Other double-blind research has confirmed IHN?s ability to improve symptoms of intermittent claudication compared with placebo.14 This treatment should be monitored by a doctor.

    3 Stars
    Osteoarthritis
    Refer to label instructions
    Supplemental niacinamide (a form of vitamin B3) has been reported to increase joint mobility, improve muscle strength, and decrease fatigue in people with osteoarthritis.

    In the 1940s and 1950s, one doctor reported that supplemental niacinamide (a form of vitamin B3) increased joint mobility, improved muscle strength, and decreased fatigue in people with osteoarthritis.15 , 16 , 17 In the 1990s, a double-blind trial confirmed a reduction in symptoms from niacinamide within 12 weeks of beginning supplementation.18 Although amounts used have varied from trial to trial, many doctors recommend 250 to 500 mg of niacinamide four or more times per day (with the higher amounts reserved for people with more advanced arthritis). The mechanism by which niacinamide reduces symptoms is not known.

    2 Stars
    Atherosclerosis
    2,000 mg per day (only under a doctor's supervision)
    [2 stars] In a preliminary trial, doctor-supervised supplementation with extended-release niacin in combination with a cholesterol-lowering statin drug appeared to reverse atherosclerosis of the carotid arteries (the arteries that supply blood to the brain).
    Niacin is known to reduce serum cholesterol levels and to increase levels of HDL ("good") cholesterol. In a preliminary trial, supplementation with extended-release niacin, when used in combination with a cholesterol-lowering statin drug, appeared to reverse atherosclerosis of the carotid arteries (the arteries that supply blood to the brain). The combination of a statin drug and niacin was significantly more effective than a statin drug combined with a second cholesterol-lowering drug (ezetimibe). In addition, the statin-niacin combination was associated with a significant reduction in the number of major cardiovascular event (such as myocardial infarction or death from coronary heart disease). Niacin was used in this study in amounts up to 2,000 mg per day.19 These large amounts of niacin have the potential to cause side effects, including liver damage, and should be taken only with the supervision of a doctor.
    2 Stars
    Dysmenorrhea (Rutin, Vitamin C)
    200 mg niacin daily, 300 mg vitamin C daily, and 60 mg rutin daily througout menstrual cycle; for cramps: 100 mg niacin every two to three hours
    Supplementing with a combination of vitamin B3, vitamin C, and the flavonoid rutin resulted in a 90% effectiveness for relieving menstrual cramps in one study.
    The niacin form of vitamin B3 has been reported to be effective in relieving menstrual cramps in 87% of a group of women taking 200 mg of niacin per day throughout the menstrual cycle. They then took 100 mg every two or three hours while experiencing menstrual cramps. In a follow-up study, this protocol was combined with 300 mg of vitamin C and 60 mg of the flavonoid rutin per day, which resulted in a 90% effectiveness for relieving menstrual cramps. Since these two preliminary studies were published many years ago, no further research has explored the relationship between niacin and dysmenorrhea. Niacin may not be effective unless taken for seven to ten days before the onset of menstrual flow.
    2 Stars
    Dysmenorrhea
    200 mg daily throughout menstrual cycle; for cramps: 100 mg every two to three hours
    The niacin form of vitamin B3 has been reported to be effective in relieving menstrual cramps in 87% of a group of women supplementing with it throughout the menstrual cycle.

    The niacin form of vitamin B3 has been reported to be effective in relieving menstrual cramps in 87% of a group of women taking 200 mg of niacin per day throughout the menstrual cycle. They then took 100 mg every two or three hours while experiencing menstrual cramps.20 In a follow-up study, this protocol was combined with 300 mg of vitamin C and 60 mg of the flavonoid rutin per day, which resulted in a 90% effectiveness for relieving menstrual cramps.21 Since these two preliminary studies were published many years ago, no further research has explored the relationship between niacin and dysmenorrhea. Niacin may not be effective unless taken for seven to ten days before the onset of menstrual flow.

    2 Stars
    High Cholesterol
    500 to 1,000 mg of inositol hexaniacinate three times daily under medical supervision
    [2 stars] Inositol hexaniacinate, a special form of vitamin B3, has been reported to lower serum cholesterol, and apparently without the toxicity of high levels of niacin.
    In an attempt to avoid the side effects of niacin, alternative health practitioners increasingly use inositol hexaniacinate , recommending 500 to 1,000 mg, taken three times per day, instead of niacin.22 , 23 This special form of niacin has been reported to lower serum cholesterol but so far has not been found to cause significant toxicity.24 Unfortunately, compared with niacin, far fewer investigations have studied the possible positive or negative effects of inositol hexaniacinate. As a result, people using inositol hexaniacinate should not take it without the supervision of a doctor, who will evaluate whether it is helpful (by measuring cholesterol levels) and will make sure that toxicity is not occurring (by measuring liver enzymes , uric acid and glucose levels, and by taking medical history and doing physical examinations).
    2 Stars
    High Triglycerides
    500 mg three times per day
    [2 stars] Some doctors recommend inositol hexaniacinate (a special form of vitamin B3) as an alternative to niacin, which can have negative side effects.
    The niacin form of vitamin B3 is used by doctors to lower cholesterol levels, but niacin also lowers TG levels. The amount of niacin needed to achieve worthwhile reductions in cholesterol and TG levels25 is several grams per day. Such quantities can cause side effects, including potential damage to the liver, and should not be taken without supervision of a doctor. Some doctors recommend inositol hexaniacinate (a special for of vitamin B3) as an alternative to niacin. A typical amount recommended is 500 mg three times per day.26 , 27 This form of vitamin B3 does not typically cause a skin flush and is said to be safer for the liver than niacin. However, the alleged safety advantage of inositol hexaniacinate needs to be confirmed by addition clinical trials. Moreover, it is not clear whether inositol hexaniacinate is as effective as niacin at lowering cholesterol and TG levels.
    2 Stars
    Peripheral Vascular Disease
    1,200 mg a day of inositol hexaniacinate
    Vitamin B3 may help prevent and treat skin ulcers caused by peripheral vascular disease.

    One controlled study compared a type of niacin (vitamin B3) known as inositol hexaniacinate to the drug pyridinolcarbamate for the treatment of skin ulcers caused by PVD.28 A placebo was not included in this trial, and both 1.2 grams daily of inositol hexaniacinate and 1.5 grams daily of the drug produced beneficial results in about half of the patients.

    2 Stars
    Raynaud?s Disease
    3 to 4 grams daily of inositol hexaniacinate
    A variation on the B vitamin niacin, inositol hexaniacinate has been shown to reduce arterial spasm and improve peripheral circulation.
    has been used with some success for relieving symptoms of Raynaud?s disease.29 In one study, 30 people with Raynaud?s disease taking 4 grams of inositol hexaniacinate each day for three months showed less spasm of their arteries.30 Another study, involving six people taking 3 grams per day of inositol hexaniacinate, again showed that this supplement improved peripheral circulation.31 People taking this supplement in these amounts should be under the care of a doctor.
    2 Stars
    Schizophrenia
    Consult a qualified healthcare practitioner
    High amounts of vitamin B3 may create a more optimal biochemical environment and increase recovery rate and reduce hospitalization and suicide rates.

    The term ?orthomolecular psychiatry? was coined by Linus Pauling in 1968 to refer to the treatment of psychiatric illnesses with substances (such as vitamins) that are normally present in the body. In orthomolecular psychiatry, high amounts of vitamins are sometimes used, not to correct a deficiency per se, but to create a more optimal biochemical environment. The mainstay of the orthomolecular approach to schizophrenia is niacin or niacinamide ( vitamin B3 ) in high amounts. In early double-blind trials, 3 grams of niacin daily resulted in a doubling of the recovery rate, a 50% reduction in hospitalization rates, and a dramatic reduction in suicide rates.32 In a preliminary trial, some schizophrenic patients continued a course of vitamins (4 to 10 grams of niacin or niacinamide, 4 grams of vitamin C , and 50 mg or more of vitamin B6 ) after being discharged from the hospital, while another group of patients discontinued the vitamins upon discharge. Both groups continued to take their psychiatric medications. Those who continued to take the vitamins had a 50% lower re-admission rate compared with those who did not.33 Several later double-blind trials, including trials undertaken by the Canadian Mental Health Association, have been unable to reproduce these positive results.34 , 35 Early supporters of niacin therapy contend that many of these trials were poorly designed.36 One clinical trial reported no greater improvement in a group of schizophrenic patients given 6 grams of niacin than in others given 3 mg of niacin; all patients were also being treated with psychiatric medications.37

    There are potential side-effects of niacin therapy, including an uncomfortable flushing sensation, dermatitis (skin inflammation), heartburn , aggravation of peptic ulcers , increased blood sugar, increased panic and anxiety , and elevation of liver enzymes , which may indicate damage to liver cells. A positive side effect of niacin therapy is reduction of cholesterol levels . Some of these effects, such as flushing, gastric upset, and reduction of serum cholesterol, do not occur with the use of niacinamide .38 Because of the seriousness of some of these side effects, high amounts of niacin should not be used without the supervision of a healthcare practitioner.

    Vitamin B6 has been used in combination with niacin in the orthomolecular approach to schizophrenia. Pioneers of orthomolecular medicine reported benefits from this combination. However, although two placebo-controlled trials found significant improvement when schizophrenic patients were given either 3 grams of niacin or 75 mg of pyridoxine along with their psychiatric medications, this improvement was lost when the two vitamins were combined.39 , 40 In a double-blind trial, schizophrenic patients were given either a vitamin program based on their individual laboratory tests or a placebo (25 mg of vitamin C ) in addition to their psychiatric medications. The vitamin program included large amounts of various B vitamins, as well as vitamin C and vitamin E . After five months, the number of patients who improved was not different in the vitamin group compared with the placebo group.41

    Clinical trials of the effects of vitamin B6 have yielded differing results. The results of supplementation with 100 mg daily in one schizophrenic patient included dramatic reduction in side effects from medication, as well as reduction in schizophrenic symptoms.42 In a preliminary trial, 60 mg per day of vitamin B6 resulted in symptomatic improvement in only 5% of schizophrenic patients after four weeks.43 Another preliminary trial, however, found that a higher amount of vitamin B6?50 mg three times daily given for eight to twelve weeks?in addition to psychiatric medications, did bring about significant improvements in schizophrenic patients. These patients experienced a better sense of well-being, increased motivation, and greater interest in their ?personal habits and their environment.?44

    2 Stars
    Type 1 Diabetes
    Consult a qualified healthcare practitioner
    Taking vitamin B3 (as niacin or niacinamide) might prevent or limit the severity of type 1 diabetes in your family.

    Taking large amounts of niacin (a form of vitamin B3), such as 2 to 3 grams per day, may impair glucose tolerance and should be used by people with diabetes only with medical supervision.45 , 46

    Some clinical trials have shown that niacinamide (another form of vitamin B3) supplementation might be useful in the very early stages of type 1 diabetes,47 though not all trials support this claim.48 , 49 , 50 Although an analysis of research shows that niacinamide does help preserve some function of insulin-secreting cells in people recently diagnosed with type 1 diabetes, the amount of insulin required for those given niacinamide has remained essentially as high as for those given placebo.51 A controlled trial found no beneficial effect of niacinamide supplementation (700 mg three times per day in addition to intensive insulin therapy) on pancreatic function and glucose tolerance in people newly diagnosed with type 1 diabetes.52

    Some,53 but not all,54 reports suggest that healthy children at high risk for type 1 diabetes (such as the healthy siblings of children with type 1 diabetes) may be protected from the disease by supplementing with niacinamide. Parents of children with type 1 diabetes should consult their doctor regarding niacinamide supplementation as a way to prevent diabetes in their other children. Although the optimal amount of niacinamide is not known, recent evidence suggests that 25 mg per 2.2 pounds of body weight per day may be as effective as higher amounts.55

    1 Star
    Alcohol Withdrawal
    Refer to label instructions
    Preliminary research has suggested that niacin may help wean some alcoholics away from alcohol. Niacinamide?a safer form of the same vitamin?might have similar actions.

    Many alcoholics are deficient in B vitamins, including vitamin B3 . John Cleary, M.D., observed that some alcoholics spontaneously stopped drinking in association with taking niacin supplements (niacin is a form of vitamin B3). Cleary concluded that alcoholism might be a manifestation of niacin deficiency in some people and recommended that alcoholics consider supplementation with 500 mg of niacin per day.56 Without specifying the amount of niacin used, Cleary?s preliminary research findings suggested that niacin supplementation helped wean some alcoholics away from alcohol.57 Activated vitamin B3 used intravenously has also helped alcoholics quit drinking.58 Niacinamide?a safer form of the same vitamin?might have similar actions and has been reported to improve alcohol metabolism in animals.59

    The daily combination of 3 grams of vitamin C , 3 grams of niacin , 600 mg of vitamin B6 , and 600 IU of vitamin E has been used by researchers from the University of Mississippi Medical Center in an attempt to reduce anxiety and depression in alcoholics.60 Although the effect of vitamin supplementation was no better than placebo in treating alcohol-associated depression, the vitamins did result in a significant drop in anxiety within three weeks of use. Because of possible side effects, anyone taking such high amounts of niacin and vitamin B6 must do so only under the care of a doctor.

    1 Star
    Anxiety
    Refer to label instructions
    Niacinamide (a form of vitamin B3) has been shown in animals to work in the brain in ways similar to anxiety medications. One study found that niacinamide helped people get through withdrawal from benzodiazepines?a common problem.

    Niacinamide (a form of vitamin B3 ) has been shown in animals to work in the brain in ways similar to drugs such as benzodiazepines (Valium-type drugs), which are used to treat anxiety.61 One study found that niacinamide (not niacin) helped people get through withdrawal from benzodiazepines?a common problem.62 A reasonable amount of niacinamide to take for anxiety, according to some doctors, is up to 500 mg four times per day.

    1 Star
    Cataracts
    40 mg daily with 3 mg daily vitamin B2
    Vitamin B3 is needed to protect glutathione, an important antioxidant in the eye.

    People with low blood levels of antioxidants and those who eat few antioxidant-rich fruits and vegetables have been reported to be at high risk for cataracts.63 , 64

    Vitamin B2 and vitamin B3 are needed to protect glutathione , an important antioxidant in the eye. Vitamin B2 deficiency has been linked to cataracts.65 , 66 Older people taking 3 mg of vitamin B2 and 40 mg of vitamin B3 per day were partly protected against cataracts in one trial.67 However, the intake of vitamin B2 in China is relatively low, and it is not clear whether supplementation would help prevent cataracts in populations where vitamin B2 intake is higher.

    1 Star
    Dermatitis Herpetiformis (Tetracycline)
    Refer to label instructions
    1 Star
    HIV and AIDS Support
    Refer to label instructions
    Vitamin B3 may play a role in HIV prevention and treatment. A form of vitamin B3 (niacinamide) has been shown to inhibit HIV in test tube studies.

    Preliminary observations suggest a possible role for vitamin B3 in HIV prevention and treatment.68 A form of vitamin B3 (niacinamide) has been shown to inhibit HIV in test tube studies.69 However, no published data have shown vitamin B3 to inhibit HIV in animals or in people. One study did show that HIV-positive people who consume more than 64 mg of vitamin B3 per day have a decreased risk of progression to AIDS or AIDS-related death.70 , 71 Clinical trials in humans are required to validate these preliminary observations.

    1 Star
    Hypoglycemia
    Refer to label instructions
    Research has shown that supplementing with niacinamide (vitamin B3) can prevent blood sugar levels from falling excessively in people with hypoglycemia.

    Research has shown that supplementing with chromium (200 mcg per day)72 or magnesium (340 mg per day)73 can prevent blood sugar levels from falling excessively in people with hypoglycemia. Niacinamide (vitamin B3) has also been found to be helpful for hypoglycemic people.74 Other nutrients, including vitamin C , vitamin E , zinc , copper , manganese , and vitamin B6 , may help control blood sugar levels in diabetics .75 Since there are similarities in the way the body regulates high and low blood sugar levels, these nutrients might be helpful for hypoglycemia as well, although the amounts needed for that purpose are not known.

    1 Star
    Hypothyroidism
    Refer to label instructions
    Vitamin B3 (niacin) supplementation may decrease thyroid hormone levels.

    Preliminary data indicate that vitamin B3 (niacin) supplementation may decrease thyroid hormone levels. In one small study, 2.6 grams of niacin per day helped lower blood fat levels.76 After a year or more, thyroid hormone levels had fallen significantly in each person, although none experienced symptoms of hypothyroidism. In another case report, thyroid hormone levels decreased in two people who were taking niacin for high cholesterol and triglycerides ; one of these two was diagnosed with hypothyroidism.77 When the niacin was discontinued for one month, thyroid hormone levels returned to normal.

    1 Star
    Multiple Sclerosis
    Refer to label instructions
    Thiamine (vitamin B1) deficiency may contribute to nerve damage. Researchers have found that injections of thiamine or thiamine combined with niacin (vitamin B3) may reduce symptoms.
    Deficiency of thiamine may contribute to nerve damage.78 Many years ago, researchers found that injecting thiamine79 into the spinal cord or using intravenous thiamine combined with niacin80 in people with MS led to a reduction in symptoms. Using injectable vitamins requires medical supervision. No research has yet studied the effects of oral supplementation with B vitamins in people with MS.
    1 Star
    Photosensitivity
    Refer to label instructions
    Niacinamide, a form of vitamin B3, can reduce the formation of a kynurenic acid?a substance that has been linked to photosensitivity.

    Niacinamide , a form of vitamin B3, can reduce the formation of a kynurenic acid?a substance that has been linked to photosensitivity. One trial studied the effects of niacinamide in people who had polymorphous light eruption.81 While taking one gram three times per day, most people remained free of problems, despite exposure to the sun. Because of the potential for adverse effects, people taking this much niacinamide should do so only under medical supervision.

    1 Star
    Tardive Dyskinesia
    Refer to label instructions
    In some studies, taking vitamin B3 as niacin or niacinamide, along with other nutrients, appeared to prevent the development of tardive dyskinesia.

    During a ten-year period, doctors at the North Nassau Mental Health Center in New York treated approximately 11,000 people with schizophrenia with a megavitamin regimen that included vitamin C (up to 4 grams per day), vitamin B3 ?either as niacin or niacinamide?(up to 4 grams per day), vitamin B6 (up to 800 mg per day), and vitamin E (up to 1,200 IU per day). During that time, not a single new case of TD was seen, even though many of the people were taking neuroleptic drugs.82 Another psychiatrist who routinely used niacinamide , vitamin C, and vitamin B-complex over a 28-year period rarely saw TD develop in her patients.83 Further research is needed to determine which nutrients or combinations of nutrients were most important for preventing TD. The amounts of niacinamide and vitamin B6 used in this research may cause significant side effects and may require monitoring by a doctor.

    1 Star
    Type 2 Diabetes
    Refer to label instructions
    Small amounts of niacin (a form of vitamin B3) may help some people with type 2 diabetes.
    The intake of large amounts of niacin (a form of vitamin B3), such as 2 to 3 grams per day, may impair glucose tolerance and should be used by people with diabetes only with medical supervision.84 , 85 Smaller amounts (500 to 750 mg per day for one month followed by 250 mg per day) may help some people with type 2 diabetes,86 though this research remains preliminary.

    How It Works

    How to Use It

    In part because it is added to white flour, most people generally get enough vitamin B3 from their diets to prevent a deficiency. However, 10?25 mg of the vitamin can be taken as part of a B-complex or multivitamin supplement. Larger amounts are used for the treatment of various health conditions.

    Where to Find It

    The best food sources of vitamin B3 are peanuts, brewer?s yeast , fish, and meat. Some vitamin B3 is also found in whole grains.

    Possible Deficiencies

    Pellagra, the disease caused by a vitamin B3 deficiency, is rare in Western societies. Symptoms include loss of appetite, skin rash, diarrhea , mental changes, beefy tongue, and digestive and emotional disturbance.

    Interactions

    Interactions with Supplements, Foods, & Other Compounds

    Vitamin B3 works with vitamin B1 and vitamin B2 to release energy from carbohydrates. Therefore, these vitamins are often taken together in a B-complex or multivitamin supplement (although most B3 research uses niacin or niacinamide alone).

    Interactions with Medicines

    Certain medicines interact with this supplement.

    Types of interactions: Beneficial Adverse Check

    Replenish Depleted Nutrients

    • Carbidopa

      A study in animals has found that carbidopa inhibits an enzyme involved in the synthesis of niacin in the body.94 In addition, there is evidence that niacin synthesis is decreased in people taking carbidopa and other drugs in its class,95 raising the concern that people taking these drugs could be at risk of niacin deficiency, even if not frankly deficient. Further studies will be required determine if niacin supplementation is appropriate in people taking carbidopa.

      The interaction is supported by preliminary,weak, fragmentary, and/or contradictory scientific evidence.
    • Carbidopa-Levodopa

      A study in animals has found that carbidopa inhibits an enzyme involved in the synthesis of niacin in the body.96 In addition, there is evidence that niacin synthesis is decreased in people taking carbidopa and other drugs in its class.97 Further studies are needed to determine whether niacin supplementation is appropriate in people taking carbidopa.

      The interaction is supported by preliminary,weak, fragmentary, and/or contradictory scientific evidence.
    • Desogestrel-Ethinyl Estradiol

      A review of literature suggests that women who use oral contraceptives may experience decreased vitamin B1 , B2 , B3 , B12 , C , and zinc levels.101 , 102 , 103 Oral contraceptive use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A .104 , 105 , 106 Oral contraceptives may interfere with manganese absorption.107 The clinical importance of these actions remains unclear.

      The interaction is supported by preliminary,weak, fragmentary, and/or contradictory scientific evidence.
    • Ethinyl Estradiol and Levonorgestrel

      A review of literature suggests that women who use oral contraceptives may experience decreased vitamin B1 , B2 , B3 , B12 , C , and zinc levels.111 , 112 , 113 Oral contraceptive use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A .114 , 115 , 116 Oral contraceptives may interfere with manganese absorption.117 The clinical importance of these actions remains unclear.

      The interaction is supported by preliminary,weak, fragmentary, and/or contradictory scientific evidence.
    • Ethinyl Estradiol and Norethindrone

      A review of literature suggests that women who use OCs may experience decreased vitamin B1 , B2 , B3 , B12 , C , and zinc levels.118 , 119 , 120 OC use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A .121 , 122 , 123 OCs may interfere with manganese absorption.124 The clinical importance of these actions remains unclear.

      The interaction is supported by preliminary,weak, fragmentary, and/or contradictory scientific evidence.
    • Ethinyl Estradiol and Norgestimate

      A review of literature suggests that women who use OCs may experience decreased vitamin B1 , B2 , B3 , B12 , C , and zinc levels.125 , 126 , 127 OC use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A .128 , 129 , 130 OCs may interfere with manganese absorption.131 The clinical importance of these actions remains unclear.

      The interaction is supported by preliminary,weak, fragmentary, and/or contradictory scientific evidence.
    • Ethinyl Estradiol and Norgestrel

      A review of literature suggests that women who use oral contraceptives may experience decreased vitamin B1 , B2 , B3 , B12 , C , and zinc levels.132 , 133 , 134 Oral contraceptive use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A .135 , 136 , 137 Oral contraceptives may interfere with manganese absorption.138 The clinical importance of these actions remains unclear.

      The interaction is supported by preliminary,weak, fragmentary, and/or contradictory scientific evidence.
    • Isoniazid

      Isoniazid is capable of causing vitamin B3 (niacin) deficiency, most likely due to its ability to interfere with cell-repair enzymes made from niacin. Significant niacin deficiency, also known as pellagra, features dermatitis, diarrhea , and dementia (impaired intellectual function). Supplementation with vitamin B6 is thought to reduce this risk, although small amounts (e.g. 10 mg daily) has been noted to be inadequate in some cases.143

    • Levonorgestrel

      A review of literature suggests that women who use oral contraceptives may experience decreased vitamin B1 , B2 , B3 , B12 , C , and zinc levels.144 , 145 , 146 Oral contraceptive use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A .147 , 148 , 149 Oral contraceptives may interfere with manganese absorption.150 The clinical importance of these actions remains unclear.

      The interaction is supported by preliminary,weak, fragmentary, and/or contradictory scientific evidence.
    • Levonorgestrel-Ethinyl Estrad

      A review of literature suggests that women who use oral contraceptives may experience decreased vitamin B1 , B2 , B3 , B12 , C , and zinc levels.151 , 152 , 153 Oral contraceptive use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A .154 , 155 , 156 Oral contraceptives may interfere with manganese absorption.157 The clinical importance of these actions remains unclear.

      The interaction is supported by preliminary,weak, fragmentary, and/or contradictory scientific evidence.
    • Mestranol and Norethindrone

      A review of literature suggests that women who use oral contraceptives may experience decreased vitamin B1 , B2 , B3 , B12 , C , and zinc levels.158 , 159 , 160 Oral contraceptive use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A .161 , 162 , 163 Oral contraceptives may interfere with manganese absorption.164 The clinical importance of these actions remains unclear.

      The interaction is supported by preliminary,weak, fragmentary, and/or contradictory scientific evidence.
    • Norgestimate-Ethinyl Estradiol

      A review of literature suggests that women who use oral contraceptives may experience decreased vitamin B1 , B2 , B3 , B12 , C , and zinc levels.172 , 173 , 174 Oral contraceptive use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A .175 , 176 , 177 Oral contraceptives may interfere with manganese absorption.178 The clinical importance of these actions remains unclear.

      The interaction is supported by preliminary,weak, fragmentary, and/or contradictory scientific evidence.
    • Tetracycline

      Taking large amounts of niacinamide, a form of vitamin B3 , can suppress inflammation in the body. According to numerous preliminary reports, niacinamide, given in combination with tetracycline or minocycline , may be effective against bullous pemphigoid, a benign, autoimmune blistering disease of the skin.185 , 186 , 187 , 188 , 189 , 190 , 191 Preliminary evidence also suggests a similar beneficial interaction may exist between tetracycline and niacinamide in the treatment of dermatitis herpetiformis .192 , 193

      The interaction is supported by preliminary,weak, fragmentary, and/or contradictory scientific evidence.

    Reduce Side Effects

    • none

    Support Medicine

    • Amitriptyline

      Combination of 6 grams per day L-tryptophan and 1,500 mg per day niacinamide (a form of vitamin B3) with imipramine has shown to be more effective than imipramine alone for people with bipolar disorder .87 These levels did not improve the effects of imipramine in people with depression . Lower amounts (4 grams per day of L-tryptophan and 1,000 mg per day of niacinamide) did show some tendency to enhance the effect of imipramine.

      The importance of the amount of L-tryptophan was confirmed in other studies, suggesting that if too much L-tryptophan (6 grams per day) is used, it is not beneficial, while levels around 4 grams per day may make tricyclic antidepressants work better.88 , 89

      The interaction is supported by preliminary,weak, fragmentary, and/or contradictory scientific evidence.
    • Amoxapine

      Combination of 6 grams per day L-tryptophan and 1,500 mg per day niacinamide (a form of vitamin B3) with imipramine has shown to be more effective than imipramine alone for people with bipolar disorder .90 These levels did not improve the effects of imipramine in people with depression . Lower amounts (4 grams per day of L-tryptophan and 1,000 mg per day of niacinamide) did show some tendency to enhance the effect of imipramine.

      The importance of the amount of L-tryptophan was confirmed in other studies, suggesting that if too much L-tryptophan (6 grams per day) is used, it is not beneficial, while levels around 4 grams per day may make tricyclic antidepressants work better.91 , 92

      The interaction is supported by preliminary,weak, fragmentary, and/or contradictory scientific evidence.
    • Benztropine

      Akathisia is an adverse reaction to anti-psychotic drugs, where a person has an uncontrollable desire to be in constant motion. One preliminary report suggested that 4,000 mg of L-tryptophan and 25 mg niacin per day taken with benztropine enhances the treatment of akathisia.93 Controlled studies are necessary to determine whether L-tryptophan and niacin supplements might benefit most people taking benztropine who experience adverse reactions to anti-psychotic drugs.

      The interaction is supported by preliminary,weak, fragmentary, and/or contradictory scientific evidence.
    • Clomipramine

      Combination of 6 grams per day L-tryptophan and 1,500 mg per day niacinamide (a form of vitamin B3) with imipramine has shown to be more effective than imipramine alone for people with bipolar disorder .98 These levels did not improve the effects of imipramine in people with depression . Lower amounts (4 grams per day of L-tryptophan and 1,000 mg per day of niacinamide) did show some tendency to enhance the effect of imipramine.

      The importance of the amount of L-tryptophan was confirmed in other studies, suggesting that if too much L-tryptophan (6 grams per day) is used, it is not beneficial, while levels around 4 grams per day may make tricyclic antidepressants work better.99 , 100

      The interaction is supported by preliminary,weak, fragmentary, and/or contradictory scientific evidence.
    • Doxepin

      Combination of 6 grams per day L-tryptophan and 1,500 mg per day niacinamide (a form of vitamin B3) with imipramine has shown to be more effective than imipramine alone for people with bipolar disorder .108 These levels did not improve the effects of imipramine in people with depression . Lower amounts (4 grams per day of L-tryptophan and 1,000 mg per day of niacinamide) did show some tendency to enhance the effect of imipramine.

      The importance of the amount of L-tryptophan was confirmed in other studies, suggesting that if too much L-tryptophan (6 grams per day) is used, it is not beneficial, while levels around 4 grams per day may make tricyclic antidepressants work better.109 , 110

      The interaction is supported by preliminary,weak, fragmentary, and/or contradictory scientific evidence.
    • Gemfibrozil

      Niacin (not niacinamide) and gemfibrozil have successfully raised HDL (good) cholesterol levels, both alone and in combination.139

    • Imipramine

      Combination of 6 grams per day L-tryptophan and 1,500 mg per day niacinamide (a form of vitamin B3) with imipramine has shown to be more effective than imipramine alone for people with bipolar disorder .140 These levels did not improve the effects of imipramine in people with depression . Lower amounts (4 grams per day of L-tryptophan and 1,000 mg per day of niacinamide) did show some tendency to enhance the effect of imipramine.

      The importance of the amount of L-tryptophan was confirmed in other studies, suggesting that if too much L-tryptophan (6 grams per day) is used, it is not beneficial, while levels around 4 grams per day may make tricyclic antidepressants work better.141 , 142

      The interaction is supported by preliminary,weak, fragmentary, and/or contradictory scientific evidence.
    • Minocycline

      Niacinamide taken in combination with minocycline has produced beneficial effects in an individual with cicatricial pemphigoid, an autoimmune blistering disease,165 as well as in a 46-year-old woman with pemphigus vegetans, another blistering disease.166 Several other studies have confirmed the efficacy of this combination for bullous (blistering) pemphigoid.167 , 168 , 169 , 170 , 171

      The interaction is supported by preliminary,weak, fragmentary, and/or contradictory scientific evidence.
    • Nortriptyline

      Combination of 6 grams per day L-tryptophan and 1,500 mg per day niacinamide (a form of vitamin B3) with imipramine has shown to be more effective than imipramine alone for people with bipolar disorder .179 These levels did not improve the effects of imipramine in people with depression . Lower amounts (4 grams per day of L-tryptophan and 1,000 mg per day of niacinamide) did show some tendency to enhance the effect of imipramine.

      The importance of the amount of L-tryptophan was confirmed in other studies, suggesting that if too much L-tryptophan (6 grams per day) is used, it is not beneficial, while levels around 4 grams per day may make tricyclic antidepressants work better.180 , 181

      The interaction is supported by preliminary,weak, fragmentary, and/or contradictory scientific evidence.
    • Protriptyline

      Combination of 6 grams per day L-tryptophan and 1,500 mg per day niacinamide (a form of vitamin B3) with imipramine has shown to be more effective than imipramine alone for people with bipolar disorder .182 These levels did not improve the effects of imipramine in people with depression . Lower amounts (4 grams per day of L-tryptophan and 1,000 mg per day of niacinamide) did show some tendency to enhance the effect of imipramine.

      The importance of the amount of L-tryptophan was confirmed in other studies, suggesting that if too much L-tryptophan (6 grams per day) is used, it is not beneficial, while levels around 4 grams per day may make tricyclic antidepressants work better.183 , 184

      The interaction is supported by preliminary,weak, fragmentary, and/or contradictory scientific evidence.
    • Thioridazine

      In a controlled study, individuals taking thioridazine for psychosis cooperated better and withdrew less from other people when niacin (nicotinic acid), 300?1,500 mg each day, was added.194 Whether people who are taking thioridazine for other mental health problems might benefit from niacin supplementation is unknown.

      The interaction is supported by preliminary,weak, fragmentary, and/or contradictory scientific evidence.
    • Trimipramine

      Combination of 6 grams per day L-tryptophan and 1,500 mg per day niacinamide (a form of vitamin B3) with imipramine has shown to be more effective than imipramine alone for people with bipolar disorder .195 These levels did not improve the effects of imipramine in people with depression . Lower amounts (4 grams per day of L-tryptophan and 1,000 mg per day of niacinamide) did show some tendency to enhance the effect of imipramine.

      The importance of the amount of L-tryptophan was confirmed in other studies, suggesting that if too much L-tryptophan (6 grams per day) is used, it is not beneficial, while levels around 4 grams per day may make tricyclic antidepressants work better.196 , 197

      The interaction is supported by preliminary,weak, fragmentary, and/or contradictory scientific evidence.

    Reduces Effectiveness

    • none

    Potential Negative Interaction

    • Glimepiride

      Vitamin B3 can raise blood sugar levels, which makes diabetes difficult to control.198 Use of niacin along with glimepiride may increase requirements for the drug. On the other hand, individuals who stop taking niacin while on glimepiride should monitor their blood for lower-than-usual glucose levels.

      The interaction is supported by preliminary,weak, fragmentary, and/or contradictory scientific evidence.

    Explanation Required

    • Atorvastatin

      Niacin is the form of vitamin B3 used to lower cholesterol . Ingestion of large amounts of niacin along with lovastatin (a drug closely related to atorvastatin) or with atorvastatin itself may cause muscle disorders (myopathy) that can become serious (rhabdomyolysis).199 , 200 Such problems appear to be uncommon when HMG-CoA reductase inhibitors are combined with niacin.201 , 202 Moreover, concurrent use of niacin with HMG-CoA reductase inhibitors has been reported to enhance the cholesterol-lowering effect of the drugs.203 , 204 Individuals taking atorvastatin should consult their physician before taking niacin.

    • Cerivastatin

      Some sources have reported that taking niacin (vitamin B3) together with HMG-CoA reductase inhibitors may result in serious muscle damage.205 However, niacin has also been used in combination with statin drugs without ill effects, and has been found to enhance the cholesterol-lowering effect of these drugs.206 , 207 Persons taking cerivastatin or any other HMG-CoA reductase inhibitor should consult with their doctor before taking niacin.

    • Fluvastatin

      Niacin is the form of vitamin B3 used to lower cholesterol. Fluvastatin and niacin used together have been shown to be more effective than either substance alone.208 Ingestion of large amounts of niacin along with HMG-CoA reductase inhibitors such as fluvastatin may cause muscle disorders (myopathy) that can become serious (rhabdomyolysis).209 , 210 Such problems appear to be uncommon.211 , 212 Nonetheless, individuals taking fluvastatin should consult with their doctor before taking niacin.

    • Lovastatin

      Niacin is a vitamin used to lower cholesterol . Large amounts of niacin taken with lovastatin have been reported to cause potentially serious muscle disorders (myopathy or rhabdomyolysis).213 However, niacin also enhances the cholesterol-lowering effect of lovastatin.214 Taking as little as 500 mg three times per day of niacin with lovastatin has been shown to have these complementary, supportive actions with almost none of the side effects seen when higher amounts of niacin are taken.215 Nevertheless, individuals taking lovastatin should consult with their doctor before taking niacin.

    • Pravastatin

      Niacin is a vitamin used to lower cholesterol. Sixteen people with diabetes and high cholesterol were given pravastatin plus niacin to lower cholesterol.216 Niacin was added over a two week period, to a maximum amount of 500 mg three times per day. The combination of pravastatin plus niacin was continued for four weeks. Compared with pravastatin, niacin plus pravastatin resulted in significantly reduced cholesterol levels. Others have also shown that the combination of pravastatin and niacin is more effective in lowering cholesterol levels than is pravastatin alone.217 However, large amounts of niacin taken with pravastatin might cause serious muscle disorders (myopathy or rhabdomyolysis).218 Individuals taking pravastatin should consult a doctor before taking niacin.

    • Repaglinide

      Supplementation with large amounts of niacin (also called nicotinic acid) can increase blood glucose levels in diabetics , which might interfere with the blood-sugar-lowering effects of repaglinide.219 The form of vitamin B3 known as niacinamide does not have this effect. People who start or stop supplementing niacin while on repaglinide should carefully monitor their blood sugar levels and consult their prescribing doctor about making adjustments in the daily amount of drug taken.

    • Rosuvastatin

      A recent blinded study showed that individuals taking both rosuvastatin and niacin had a greater increase in HDL (?good?) cholesterol and apolipoprotein A-I than did those taking rosuvastatin alone.220 People taking rosuvastatin might benefit from taking niacin, though they should consult with their healthcare provider before starting the supplement. When taken with niacin, some statin drugs may become more toxic so there is a possibility of an adverse interaction.

    • Simvastatin

      Niacin is the form of vitamin B3 used to lower cholesterol. Taking large amounts of niacin along with HMG-CoA reductase inhibitors may cause muscle disorders (myopathy) that can become serious (rhabdomyolysis).221 , 222 Such problems appear to be uncommon.223 , 224 Moreover, concurrent use of niacin has been reported to enhance the cholesterol-lowering effect of HMG-CoA reductase inhibitors.225 , 226 Individuals taking simvastatin should consult a doctor before taking niacin.

    The Drug-Nutrient Interactions table may not include every possible interaction. Taking medicines with meals, on an empty stomach, or with alcohol may influence their effects. For details, refer to the manufacturers? package information as these are not covered in this table. If you take medications, always discuss the potential risks and benefits of adding a supplement with your doctor or pharmacist.

    Side Effects

    Side Effects

    Niacinamide is almost always safe to take in amounts of 1,000 mg per day or less, though rare liver problems have occurred at amounts in excess of 1,000 mg per day. Niacin, in amounts as low as 50?100 mg, may cause flushing, headache, and stomachache in some people. Doctors sometimes prescribe very high amounts of niacin (as much as 3,000 mg per day or more) for certain health problems. These large amounts can cause liver damage, diabetes , gastritis , damage to eyes, and elevated blood levels of uric acid (which can cause gout ). Symptoms caused by niacin supplements, such as flushing, have been reduced with sustained-release (also called ?time-release?) niacin products. However, sustained-release forms of niacin have caused significant liver toxicity in some cases and, rarely, liver failure.227 , 228 , 229 , 230 , 231 One partial time-release (intermediate-release) niacin product has demonstrated clinical efficacy without flushing, and also with much less ofthe liver function abnormalities typically associated with sustained-release niacin formulations.232 However, this form of niacin is available by prescription only.

    In a controlled clinical trial, 1,000 mg or more per day of niacin raised blood levels of homocysteine , a substance associated with increased risk of heart disease .233 Since other actions of niacin lower heart disease risk,234 , 235 the importance of this finding is unclear. Nonetheless, for all of the reasons discussed above, large amounts of niacin should never be taken without consulting a doctor.

    The inositol hexaniacinate form of niacin has not been linked with the side effects associated with niacin supplementation. In a group of people being treated alternatively with niacin and inositol hexaniacinate for skin problems, niacin supplementation (50?100 mg per day) was associated with numerous side effects, including skin flushing, nausea, vomiting and agitation.236 In contrast, people taking inositol hexaniacinate experienced no complaints whatsoever, even at amounts two to five times higher than the previously used amounts of niacin. However, the amount of research studying the safety of inositol hexaniacinate remains quite limited. Therefore, people taking this supplement in large amounts (2,000 mg or more per day) should be under the care of a doctor.

    References

    1. Shality AR, Smith JR, Parish LC, et al. Topical nicotinamide compared with clindamycin gel in the treatment of inflammatory acne vulgaris. Internat J Dermatol 1995;34:434?7.

    2. Brown WV. Niacin for lipid disorders. Postgrad Med 1995;98:185?93 [review].

    3. Guyton JR, Blazing MA, Hagar J, et al. Extended-release niacin vs gemfibrozil for the treatment of low levels of high-density lipoprotein cholesterol. Niaspan-Gemfibrozil Study Group. Arch Intern Med 2000;160:1177?84.

    4. McKenney JM, Proctor JD, Harris S, Chinchili VM. A comparison of the efficacy and toxic effects of sustained- vs immediate-release niacin in hypercholesterolemic patients. JAMA 1994;271:672?7.

    5. Knopp RH, Ginsberg J, Albers JJ, et al. Contrasting effects of unmodified and time-release forms of niacin on lipoproteins in hyperlipidemic subjects: clues to mechanism of action of niacin. Metabolism 1985;34:642?50.

    6. Gray DR, Morgan T, Chretien SD, Kashyap ML. Efficacy and safety of controlled-release niacin in dyslipoproteinemic veterans. Ann Intern Med 1994;121:252?8.

    7. Rader JI, Calvert RJ, Hathcock JN. Hepatic toxicity of unmodified and time-release preparations of niacin. Am J Med 1992;92:77?81 [review].

    8. Knopp RH. Niacin and hepatic failure. Ann Intern Med 1989;111:769 [letter].

    9. Goldberg A, Alagona P Jr, Capuzzi DM, et al. Multiple-dose efficacy and safety of an extended-release form of niacin in the management of hyperlipidemia. Am J Cardiol 2000;85:1100?5.

    10. Brown WV. Niacin for lipid disorders. Postgrad Med 1995;98:183?93 [review].

    11. Head KA. Inositol hexaniacinate: a safer alternative to niacin. Altern Med Rev 1996;1:176?84 [review].

    12. Murray M. Lipid-lowering drugs vs. inositol hexaniacinate. Am J Natural Med 1995;2(8):9?12 [review].

    13. Kiff RS, Wuick CRG. Does inositol nicotinate (Hexopal) influence intermittent claudication??a controlled trial. Br J Clin Pract 1988;42:141?5.

    14. O?Hara J, Jolly PN, Nicol CG. The therapeutic efficacy of inositol nicotinate (Hexopal) in intermittent claudication: a controlled trial. Br J Clin Pract 1988;42:377?83.

    15. Kaufman W. The use of vitamin therapy for joint mobility. Therapeutic reversal of a common clinical manifestation of the ?normal? aging process. Conn State Med J 1953;17(7):584?9.

    16. Kaufman W. The use of vitamin therapy to reverse certain concomitants of aging. J Am Geriatr Soc 1955;11:927.

    17. Hoffer A. Treatment of arthritis by nicotinic acid and nicotinamide. Can Med Assoc J 1959;81:235?8.

    18. Jonas WB, Rapoza CP, Blair WF. The effect of niacinamide on osteoarthritis: a pilot study. Inflamm Res 1996;45:330?4.

    19. Taylor AJ, Villines TC, Stanek EJ, et al. Extended-release niacin or ezetimibe and carotid intima-media thickness. N Engl J Med 2009 [E-pub ahead of print].

    20. Hudgins AP. Am Practice Digest Treat 1952;3:892?3.

    21. Hudgins AP. Vitamins P, C and niacin for dysmenorrhea therapy. West J Surg 1954;Dec:610?1.

    22. Head KA. Inositol hexaniacinate: a safer alternative to niacin. Alt Med Rev 1996;1:176?84 [review].

    23. Murray M. Lipid-lowering drugs vs. Inositol hexaniacinate. Am J Natural Med 1995;2:9?12 [review].

    24. Dorner Von G, Fisher FW. Zur Beinflussung der Serumlipide und-lipoproteine durch den Hexanicotinsaureester des m-Inositol. Arzneimittel Forschung 1961;11:110?3.

    25. Brown WV. Niacin for lipid disorders. Postgrad Med 1995;98:183?93 [review].

    26. Head KA. Inositol hexaniacinate: a safer alternative to niacin. Altern Med Rev 1996;1:176?84 [review].

    27. Murray M. Lipid-lowering drugs vs. inositol hexaniacinate. Am J Natural Med 1995;2(8):9?12 [review].

    28. Mishima Y, Kamiya K, Sakaguchi S, et al. A multiclinic double-blind trial of pyridinolcarbamate and inositol niacinate in ischemic ulcer due to chronic arterial occlusion. Angiology 1977;28:84?94.

    29. Aylward M. Hexopal in Raynaud?s disease. J Int Med Res 1979;7:484?91.

    30. Holti G. An experimentally controlled evaluation of the effect of inositol nicotinate upon the digital blood flow in patients with Raynaud?s phenomenon. J Int Med Res 1979;7:473?83.

    31. Ring EF, Bacon PA. Quantitative thermographic assessment of inositol nicotinate therapy in Raynaud?s phenomenon. J Int Med Res 1977;5:217?22.

    32. Hawkins DR, Bortin AW, Runyon RP. Orthomolecular psychiatry: niacin and megavitamin therapy. Psychosomatics 1970;11:517?21 [review].

    33. Hawkins DR, Bortin AW, Runyon RP. Orthomolecular psychiatry: niacin and megavitamin therapy. Psychosomatics 1970;11:517?21 [review].

    34. Autry JH. Workshop on orthomolecular treatment of schizophrenia: a report. Schizophr Bull 1975:94?103.

    35. Petrie WM, Ban TA. Vitamins in psychiatry. Do they have a role? Drugs 1985;30:58?65 [review].

    36. Hoffer A. Megavitamin B-3 therapy for schizophrenia. Can Psychiatr Assoc J 1971;16:499?504.

    37. Wittenborn JR, Weber ES, Brown M. Niacin in the long-term treatment of schizophrenia. Arch Gen Psychiatry 1973;28:308?15.

    38. Newbold HL, Mosher LR. Niacin and the schizophrenic patient. Am J Psychiatry 1970;127:535?6.

    39. Petrie WM, Ban TA, Ananth JV. The use of nicotinic acid and pyridoxine in the treatment of schizophrenia. IntPharmacopsychiatry 1981;16:245?50.

    40. Ananth JV, Ban TA, Lehmann HE. Potentiation of therapeutic effects of nicotinic acid by pyridoxine in chronic schizophrenics. Can Psychiatr Assoc J 1973;18:377?83.

    41. Vaughan K, McConaghy N. Megavitamin and dietary treatment in schizophrenia: a randomised, controlled trial. Aust N Z J Psychiatry 1999;33:84?8.

    42. Sandyk R, Pardeshi R. Pyridoxine improves drug-induced parkinsonism and psychosis in a schizophrenic patient. Int J Neurosci 1990;52:225?32.

    43. Yamauchi M. Effects of L-dopa and vitamin B6 on electroencephalograms of schizophrenic patients: a preliminary report. Folia Psychiatr Neurol Jpn 1976;30:121?51.

    44. Bucci L. Pyridoxine and schizophrenia. Br J Psychiatry 1973;122:240 [letter].

    45. Molnar GD, Berge KG, Rosevear JW, et al. The effect of nicotinic acid in diabetes mellitus. Metabolism1964;13:181?9.

    46. Gaut ZN, Pocelinko R, Solomon HM, Thomas GB. Oral glucose tolerance, plasma insulin, and uric acid excretion in man during chronic administration in nicotinic acid. Metabolism1971;20:1031?5.

    47. Clearly JP. Vitamin B3 in the treatment of diabetes mellitus: case reports and review of the literature. J Nutr Med 1990;1:217?25.

    48. Lewis CM, Canafax DM, Sprafka JM, Bazrbosa JJ. Double-blind randomized trail of nicotinamide on early-onset diabetes. Diabetes Care 1992;15:121?3.

    49. Chase HP, Butler-Simon N, Garg S, et al. A trial of nicotinamide in newly diagnosed patients with type 1 (insulin-dependent) diabetes mellitus. Diabetologia1990;33:444?6.

    50. Mendola G, Casamitjana R, Gomis R. Effect of nicotinamide therapy upon B-cell function in newly diagnosed type 1 (insulin-dependent) diabetic patients. Diabetologia1989;32:160?2.

    51. Pozzilli P, Browne PD, Kolb H. Meta-analysis of nicotinamide treatment in patients with recent-onset type 1. The nicotinamide trialists. Diabetes Care 1996;19:1357?63.

    52. Vidal J, Fernandez-Balsells M, Sesmilo G, Aguilera E. Effects of nicotinamide and intravenous insulin therapy in newly diagnosed type 1 diabetes. Diabetes Care 2000;23:360?4.

    53. Elliott RB, Picher CC, Fergusson DM, Stewart AW. A population based strategy to prevent insulin-dependent diabetes using nicotinamide. J Pediatr Endocrinol Metab 1996;9:501?9.

    54. Lampeter EF, Klinghammer A, Scherbaum WA, et al. The Deutsche Nicotinamide Intervention Study. An attempt to prevent type 1 diabetes. Diabetes1998;47:980?4.

    55. Visalli N, Cavallo MG, Signore A, et al. A multi-centre randomized trial of two different doses of nicotinamide in patients with recent-onset type 1 diabetes (The IMDIAB VI). Diabetes Metab Res Rev 1999;15:181?5.

    56. Cleary JP. Etiology and biological treatment of alcohol addiction. J Neuro Ortho Med Surg 1985;6:75?7.

    57. Smith RF. A five-year field trial of massive nicotinic acid therapy of alcoholics in Michigan. J Orthomolec Psychiatry 1974;3:327?31.

    58. O?Halloren P. Pyridine nucleotides in the prevention, diagnosis and treatment of problem drinkers. West J Surg Obstet Gynecol 1961;69:101?4.

    59. Eriksson CJP. Increase in hepatic NAD level?its effect on the redox state and on ethanol and acetaldehyde metabolism. Fed Eur Biochem Soc 1974;40:3117?20.

    60. Replogle WH, Eicke FJ. Megavitamin therapy in the reduction of anxiety and depression among alcoholics. J Orthomolec Med 1988;4:221?4.

    61. Mohler H, Polc P, Cumin R, et al. Niacinamide is a brain constituent with benzodiazepine-like actions. Nature 1979;278:563?5.

    62. Vescovi PP, et al. Nicotinic acid effectiveness in the treatment of benzodiazepine withdrawal. Curr Ther Res 1987;41:1017.

    63. Jacques PF, Chylack LT Jr. Epidemiologic evidence of a role for the antioxidant vitamins and carotenoids in cataract prevention. Am J Clin Nutr 1991;53:352S?5S.

    64. Knekt P, Heliovaara M, Rissanen A, et al. Serum antioxidant vitamins and risk of cataract. BMJ 1992;305:1392?4.

    65. Bhat KS. Nutritional status of thiamine, riboflavin and pyridoxine in cataract patients. Nutr Rep Internat 1987;36:685?92.

    66. Prchal JT, Conrad ME, Skalka HW. Association of presenile cataracts with heterozygosity for galactosaemic states and with riboflavin deficiency. Lancet 1978; 1:12?3.

    67. Sperduto RD, Hu TS, Milton RC, et al. The Linxian cataract studies. Arch Ophthalmol 1993;111:1246?53.

    68. Murray MF. Niacin as a potential AIDS preventive factor. Med Hypotheses 1999;53:375?9.

    69. Murray MF, Srinivasan A. Nicotinamide inhibits HIV-1 in both acute and chronic in vitro infection. Biochem Biophys Res Commun 1995;210:954?9.

    70. Tang AM, Graham NMH, Saah AJ. Effects of micronutrient intake on survival in human immunodeficiency type 1 infection. Am J Epidemiol 1996;143:1244?56.

    71. Graham NMH, Saah AJ. Effects of micronutrient intake on survival in human immunodeficiency type 1 infection. Am J Epidemiol 1996;143:1244?56.

    72. Anderson RA et al. Chromium supplementation of humans with hypoglycemia. Fed Proc 1984;43:471.

    73. Stebbing JB et al. Reactive hypoglycemia and magnesium. Magnesium Bull 1982;2:131?4.

    74. Shansky A. Vitamin B3 in the alleviation of hypoglycemia. Drug Cosm Ind 1981;129(4):68?69,104?5.

    75. Gaby AR, Wright JV. Nutritional regulation of blood glucose. J Advancement Med 1991;4:57?71.

    76. Shakir KMM, Kroll S, Aprill BS, et al. Nicotinic acid decreases serum thyroid hormone levels while maintaining a euthyroid state. Mayo Clin Proc 1995;70:556?8.

    77. O?Brien T, Silverberg JD, Nguyen TT. Nicotinic acid-induced toxicity associated with cytopenia and decreased levels of thyroxine-binding globulin. Mayo Clin Proc 1992;67:465?8.

    78. Dines KC, Powell HC. Mast cell interactions with the nervous system: relationship to mechanisms of disease. J Neuropathol Exp Neurol 1997;56:627?40.

    79. Stern EI. The intraspinal injection of vitamin B1 for the relief of intractable pain, and for inflammatory and degenerative diseases of the central nervous system. Am J Surg 1938;34:495.

    80. Moore MT. Treatment of multiple sclerosis with nicotinic acid and vitamin B1. Arch Int Med 1940;65:18.

    81. Neumann R, Rappold E, Pohl-Markl H. Treatment of polymorphous light eruption with nicotinamide: a pilot study. Br J Dermatol 1986;115:77?80.

    82. Tkacz C. A preventive measure for tardive dyskinesia. J Int Acad Prev Med 1984;8:(5)5?8.

    83. Toll N. To the editor. J Orthomolec Psychiatry 1982;11:42.

    84. Molnar GD, Berge KG, Rosevear JW, et al. The effect of nicotinic acid in diabetes mellitus. Metabolism 1964;13:181?9.

    85. Gaut ZN, Pocelinko R, Solomon HM, Thomas GB. Oral glucose tolerance, plasma insulin, and uric acid excretion in man during chronic administration in nicotinic acid. Metabolism 1971;20:1031?5.

    86. Clearly JP. The importance of oxidant injury as a cause of impaired mitochondrial oxidation in diabetes. J Orthomolec Med 1988;3:164?74.

    87. Chouinard G, Young SN, Annable L, Sourkes TL. Tryptophan-nicotinamide, imipramine and their combination in depression. Acta Psychiatr Scand 1979;59:395?414.

    88. Walinder J, Skott A, Carlsson A, et al. Potentiation of the antidepressant action of clomipramine by tryptophan. Arch Gen Psychiatry 1976;33:1384?9.

    89. Shaw DM, MacSweeney DA, Hewland R, Johnson AL. Tricyclic antidepressants and tryptophan in unipolar depression. Psychol Med 1975;5:276?8.

    90. Chouinard G, Young SN, Annable L, Sourkes TL. Tryptophan-nicotinamide, imipramine and their combination in depression. Acta Psychiatr Scand 1979;59:395?414.

    91. Walinder J, Skott A, Carlsson A, et al. Potentiation of the antidepressant action of clomipramine by tryptophan. Arch Gen Psychiatry 1976;33:1384?9.

    92. Shaw DM, MacSweeney DA, Hewland R, Johnson AL. Tricyclic antidepressants and tryptophan in unipolar depression. Psychol Med 1975;5:276?8.

    93. Kramer MS, DiJohnson C, Davis P, et al. L-tryptophan in neuroleptic-induced akathisia. Biol Psychiatry 1990;27:671?2.

    94. Bender DA, Smith WR. Inhibition of kynurenine hydrolase by benserazide, carbidopa and other aromatic hydrazine derivatives: evidence for sub-clinical iatrogenic niacin deficiency. Biochem Soc Trans 1978;6:120?2.

    95. Bender DA, Earl CJ, Lees AJ. Niacin depletion in Parkinsonian patients treated with L-dopa, benserazide and carbidopa. Clin Sci 1979;56:89?93.

    96. Bender DA, Smith WR. Inhibition of kynurenine hydrolase by benserazide, carbidopa and other aromatic hydrazine derivatives: evidence for sub-clinical iatrogenic niacin deficiency. Biochem Soc Trans 1978;6:120?2.

    97. Bender DA, Earl CJ, Lees AJ. Niacin depletion in Parkinsonian patients treated with L-dopa, benserazide and carbidopa. Clin Sci 1979;56:89?93.

    98. Chouinard G, Young SN, Annable L, Sourkes TL. Tryptophan-nicotinamide, imipramine and their combination in depression. Acta Psychiatr Scand 1979;59:395?414.

    99. Walinder J, Skott A, Carlsson A, et al. Potentiation of the antidepressant action of clomipramine by tryptophan. Arch Gen Psychiatry 1976;33:1384?9.

    100. Shaw DM, MacSweeney DA, Hewland R, Johnson AL. Tricyclic antidepressants and tryptophan in unipolar depression. Psychol Med 1975;5:276?8.

    101. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210?1 [review].

    102. Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561?4.

    103. Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197?8.

    104. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210?1 [review].

    105. Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561?4.

    106. Berg G, Kohlmeier L, Brenner H. Effect of oral contraceptive progestins on serum copper concentration. Eur J Clin Nutr 1998;52:711?5.

    107. Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197.

    108. Chouinard G, Young SN, Annable L, Sourkes TL. Tryptophan-nicotinamide, imipramine and their combination in depression. Acta Psychiatr Scand 1979;59:395?414.

    109. Walinder J, Skott A, Carlsson A, et al. Potentiation of the antidepressant action of clomipramine by tryptophan. Arch Gen Psychiatry 1976;33:1384?9.

    110. Shaw DM, MacSweeney DA, Hewland R, Johnson AL. Tricyclic antidepressants and tryptophan in unipolar depression. Psychol Med 1975;5:276?8.

    111. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210?1 [review].

    112. Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561?4.

    113. Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197?8.

    114. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210?1 [review].

    115. Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561?4.

    116. Berg G, Kohlmeier L, Brenner H. Effect of oral contraceptive progestins on serum copper concentration. Eur J Clin Nutr 1998;52:711?5.

    117. Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197.

    118. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210?1 [review].

    119. Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561?4.

    120. Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197?8.

    121. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210?1 [review].

    122. Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561?4.

    123. Berg G, Kohlmeier L, Brenner H. Effect of oral contraceptive progestins on serum copper concentration. Eur J Clin Nutr 1998;52:711?5.

    124. Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197.

    125. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210?1 [review].

    126. Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561?4.

    127. Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197?8.

    128. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210?1 [review].

    129. Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561?4.

    130. Berg G, Kohlmeier L, Brenner H. Effect of oral contraceptive progestins on serum copper concentration. Eur J Clin Nutr 1998;52:711?5.

    131. Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197.

    132. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210?1 [review].

    133. Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561?4.

    134. Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197?8.

    135. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210?1 [review].

    136. Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561?4.

    137. Berg G, Kohlmeier L, Brenner H. Effect of oral contraceptive progestins on serum copper concentration. Eur J Clin Nutr 1998;52:711?5.

    138. Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197.

    139. Zema MJ. Gemfibrozil, nicotinic acid and combination therapy in patients with isolated hypoalphalipoproteinemia: a randomized, open-label, crossover study. J Am Coll Cardiol 2000;35:640?6.

    140. Chouinard G, Young SN, Annable L, Sourkes TL. Tryptophan-nicotinamide, imipramine and their combination in depression. Acta Psychiatr Scand 1979;59:395?414.

    141. Walinder J, Skott A, Carlsson A, et al. Potentiation of the antidepressant action of clomipramine by tryptophan. Arch Gen Psychiatry 1976;33:1384?9.

    142. Shaw DM, MacSweeney DA, Hewland R, Johnson AL. Tricyclic antidepressants and tryptophan in unipolar depression. Psychol Med 1975;5:276?8.

    143. Darvay A, Basarab T, McGregor JM, Russell-Jones R. Isoniazid induced pellagra despite pyridoxine supplementation. Clin Exp Dermatol 1999;24:167?70.

    144. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210?1 [review].

    145. Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561?4.

    146. Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197?8.

    147. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210?1 [review].

    148. Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561?4.

    149. Berg G, Kohlmeier L, Brenner H. Effect of oral contraceptive progestins on serum copper concentration. Eur J Clin Nutr 1998;52:711?5.

    150. Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197.

    151. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210?1 [review].

    152. Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561?4.

    153. Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197?8.

    154. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210?1 [review].

    155. Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561?4.

    156. Berg G, Kohlmeier L, Brenner H. Effect of oral contraceptive progestins on serum copper concentration. Eur J Clin Nutr 1998;52:711?5.

    157. Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197.

    158. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210?1 [review].

    159. Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561?4.

    160. Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197?8.

    161. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210?1 [review].

    162. Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561?4.

    163. Berg G, Kohlmeier L, Brenner H. Effect of oral contraceptive progestins on serum copper concentration. Eur J Clin Nutr 1998;52:711?5.

    164. Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197.

    165. Reiche L, Wojnarowska F, Mallon E. Combination therapy with nicotinamide and tetracyclines for cicatricial pemphigoid; further support for its efficacy. Clin Exp Dermatol 1998;23:254?7.

    166. Sawai T, Kitazawa K, Danno K, et al. Pemphigus vegetans with oesophageal involvement: successful treatment with minocycline and nicotinamide. Br J Dermatol 1995;132:668?70.

    167. Yomoda M, Komai A, Hasimoto T. Sublamina densa-type linear IgA bullous dermatosis successfully treated with oral tetracycline and niacinamide. Br J Dermatol 1999;141:608?9.

    168. Berk MA, Lorincz AL. The treatment of bullous pemphigoid with tetracycline and niacinamide. A preliminary report. Arch Dermatol 1986;122:670?4.

    169. Kawahara Y, Hashimoto T, Ohata K, Nishikawa T. Eleven cases of bullous pemphigoid treated with combination of minocycline and nicotinamide. Eur J Dermatol 1996;6:427?9.

    170. Peoples D, Fivenson DP. Linear IgA bullous dermatosis: successful treatment with tetracycline and nicotinamide. J Am Acad Dermatol 1992;26:498?9.

    171. Chaffins ML, Collison D, Fivenson DP. Treatment of pemphigus and linear IgA dermatosis with nicotinamide and tetracycline: a review of 13 cases. J Am Acad Dermatol 1993;28:998?1000.

    172. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210?1 [review].

    173. Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561?4.

    174. Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197?8.

    175. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210?1 [review].

    176. Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561?4.

    177. Berg G, Kohlmeier L, Brenner H. Effect of oral contraceptive progestins on serum copper concentration. Eur J Clin Nutr 1998;52:711?5.

    178. Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197.

    179. Chouinard G, Young SN, Annable L, Sourkes TL. Tryptophan-nicotinamide, imipramine and their combination in depression. Acta Psychiatr Scand 1979;59:395?414.

    180. Walinder J, Skott A, Carlsson A, et al. Potentiation of the antidepressant action of clomipramine by tryptophan. Arch Gen Psychiatry 1976;33:1384?9.

    181. Shaw DM, MacSweeney DA, Hewland R, Johnson AL. Tricyclic antidepressants and tryptophan in unipolar depression. Psychol Med 1975;5:276?8.

    182. Chouinard G, Young SN, Annable L, Sourkes TL. Tryptophan-nicotinamide, imipramine and their combination in depression. Acta Psychiatr Scand 1979;59:395?414.

    183. Walinder J, Skott A, Carlsson A, et al. Potentiation of the antidepressant action of clomipramine by tryptophan. Arch Gen Psychiatry 1976;33:1384?9.

    184. Shaw DM, MacSweeney DA, Hewland R, Johnson AL. Tricyclic antidepressants and tryptophan in unipolar depression. Psychol Med 1975;5:276?8.

    185. Yomoda M, Komai A, Hasimoto T. Sublamina densa-type linear IgA bullous dermatosis successfully treated with oral tetracycline and niacinamide. Br J Dermatol 1999;141:608?9.

    186. Dragan L, Eng AM, Lam S, Persson T. Tetracycline and niacinamide: treatment alternatives in ocular cicatricial pemphigoid. Cutis 1999;63:181?3.

    187. Berk MA, Lorincz AL. The treatment of bullous pemphigoid with tetracycline and niacinamide. A preliminary report. Arch Dermatol 1986;122:670?4.

    188. Kawahara Y, Hashimoto T, Ohata K, Nishikawa T. Eleven cases of bullous pemphigoid treated with combination of minocycline and nicotinamide. Eur J Dermatol 1996;6:427?9.

    189. Reiche L, Wojnarowska F, Mallon E. Combination therapy with nicotinamide and tetracyclines for cicatricial pemphigoid: further support for its efficacy. Clin Exp Dermatol 1998;23:254?7.

    190. Peoples D, Fivenson DP. Linear IgA bullous dermatosis: successful treatment with tetracycline and nicotinamide. J Am Acad Dermatol 1992;26:498?9.

    191. Chaffins ML, Collison D, Fivenson DP. Treatment of pemphigus and linear IgA dermatosis with nicotinamide and tetracycline: a review of 13 cases. J Am Acad Dermatol 1993;28:998?1000.

    192. Shah SA, Ormerod AD. Dermatitis herpetiformis effectively treated with heparin, tetracycline and nicotinamide. Clin Exp Dermatol 2000;25:204?5.

    193. Zemtsov A, Neldner KH. Successful treatment of dermatitis herpetiformis with tetracycline and nicotinamide in a patient unable to tolerate dapsone. J Am Acad Dermatol 1993;28:505?6.

    194. Lehmann HE, Ban TA, Saxena BM. Nicotinic acid, thioridazine, fluoxymesterone and their combinations in hospitalized geriatric patients. Can Psychiatr Assoc J 1972;17:315?20.

    195. Chouinard G, Young SN, Annable L, Sourkes TL. Tryptophan-nicotinamide, imipramine and their combination in depression. Acta Psychiatr Scand 1979;59:395?414.

    196. Walinder J, Skott A, Carlsson A, et al. Potentiation of the antidepressant action of clomipramine by tryptophan. Arch Gen Psychiatry 1976;33:1384?9.

    197. Shaw DM, MacSweeney DA, Hewland R, Johnson AL. Tricyclic antidepressants and tryptophan in unipolar depression. Psychol Med 1975;5:276?8.

    198. Sifton DW, ed. Physicians Desk Reference. Montvale, NJ: Medical Economics Company, Inc., 2000, 1346?9.

    199. Garnett WR. Interactions with hydroxymethylglutaryl-coenzyme A reductase inhibitors. Am J Health Syst Pharm 1995;52:1639?45.

    200. Yee HS, Fong NT. Atorvastatin in the treatment of primary hypercholesterolemia and mixed dyslipidemias. Ann Pharmacother 1998;32:1030?43.

    201. Jacobson TA, Amorosa LF. Combination therapy with fluvastatin and niacin in hypercholesterolemia: a preliminary report on safety. Am J Cardiol 1994;73:25D?9D.

    202. Jokubaitis LA. Fluvastatin in combination with other lipid-lowering agents. Br J Clin Pract Suppl 1996;77A:28?32.

    203. Davignon J, Roederer G, Montigny M, et al. Comparative efficacy and safety of pravastatin, Nicotinic acid and the two combined in patients with hypercholesterolemia. Am J Cardiol 1994;73:339?45.

    204. Jacobson TA, Jokubaitis LA, Amorosa LF. Fluvistatin and niacin in hypercholesterolemia: a preliminary report on gender differences in efficacy. Am J Med 1994;96(suppl 6A):64S?8S.

    205. Sifton DW, et. Physicians? Desk Reference. Montvale, NJ: Medical Economics Company, Inc., 2000, 675?7.

    206. Davignon J, Roederer G, Montigny M, et al. Comparative efficacy and safety of pravastatin, nicotinic acid and the two combined in patients with hypercholesterolemia. Am J Cardiol 1994;73:339?45.

    207. Jacobson TA, Jokubaitis LA, Amorosa LF. Fluvastatin and niacin in hypercholesterolemia: a preliminary report on gender differences in efficacy. Am J Med 1994;96(suppl 6A):64S?8S.

    208. Jacobson TA, Chin MM, Fromell GJ, et al. Fluvastatin with and without niacin for hypercholesterolemia. Am J Cardiol 1994;74:149?54.

    209. Garnett WR. Interactions with hydroxymethylglutaryl-coenzyme A reductase inhibitors. Am J Health Syst Pharm 1995;52:1639?45.

    210. Yee HS, Fong NT. Atorvastatin in the treatment of primary hypercholesterolemia and mixed dyslipidemias. Ann Pharmacother 1998;32:1030?43.

    211. Jacobson TA, Amorosa LF. Combination therapy with fluvastatin and niacin in hypercholesterolemia: a preliminary report on safety. Am J Cardiol 1994;73:25D?9D.

    212. Jokubaitis LA. Fluvastatin in combination with other lipid-lowering agents. Br J Pract Suppl 1996;77A:28?32.

    213. Garnett WR. Interactions with hydroxymethylglutaryl-coenzyme A reductase inhibitors. Am J Health Syst Pharm 1995;52:1639?45.

    214. Malloy MJ, Kane JP, Kunitake ST, Tun P. Complementarity of colestipol, niacin, and lovastatin in treatment of severe familial hypercholesterolemia. Ann Intern Med 1987;107:616?23.

    215. Gardner SF, Schneider EF, Granberry MG, Carter IR. Combination therapy with low-dose lovastatin and niacin is as effective as higher-dose lovastatin. Pharmacotherapy 1996;16:419?23.

    216. Gardner SF, Marx MA, White LM, et al. Combination of low-dose niacin and pravastatin improves the lipid profile in diabetic patients without compromising glycemic control. Ann Pharmacother 1997;31:677?82.

    217. O?Keefe JH Jr, Harris WS, Nelson J, Windsor SL. Effects of pravastatin with niacin or magnesium on lipid levels and postprandial lipemia. Am J Cardiol 1995;76:480?4.

    218. Garnett WR. Interactions with hydroxymethylglutaryl-coenzyme A reductase inhibitors. Am J Health Syst Pharm 1995;52:1639?45.

    219. Sifton DW, ed. Physicians Desk Reference. Montvale, NJ: Medical Economics Company, Inc., 2000, 2071?3.

    220. Capuzzi DM, Morgan JM, Weiss RJ, et al. Beneficial effects of rosuvastatin alone and in combination with extended-release niacin in patients with a combined hyperlipidemia and low high-density lipoprotein cholesterol levels. Am J Cardiol 2003;91:1304?10.

    221. Garnett WR. Interactions with hydroxymethylglutaryl-coenzyme A reductase inhibitors. Am J Health Syst Pharm 1995;52:1639?45.

    222. Yee HS, Fong NT. Atorvastatin in the treatment of primary hypercholesterolemia and mixed dyslipidemias. Ann Pharmacother 1998;32:1030?43.

    223. Jacobson TA, Amorosa LF. Combination therapy with fluvastatin and niacin in hypercholesterolemia: a preliminary report on safety. Am J Cardiol 1994;73:25D?9D.

    224. Jokubaitis LA. Fluvastatin in combination with other lipid-lowering agents. Br J Pract Suppl 1996;77A:28?32.

    225. Davignon J, Roederer G, Montigny M, et al. Comparative efficacy and safety of pravastatin, Nicotinic acid and the two combined in patients with hypercholesterolemia. Am J Cardiol 1994;73:339?45.

    226. Jacobson TA, Jokubaitis LA, Amorosa LF. Fluvastatin and niacin in hypercholesterolemia: a preliminary report on gender differences in efficacy. Am J Med 1994;96(suppl 6A):64S?8S.

    227. McKenney JM, Proctor JD, Harris S, Chinchili VM. A comparison of the efficacy and toxic effects of sustained?vs immediate-release niacin in hypercholesterolemic patients. JAMA 1994;271:672?7.

    228. Knopp RH, Ginsberg J, Albers JJ, et al. Contrasting effects of unmodified and time-release forms of niacin on lipoproteins in hyperlipidemic subjects: clues to mechanism of action of niacin. Metabolism 1985;34:642?50.

    229. Gray DR, Morgan T, Chretien SD, Kashyap ML. Efficacy and safety of controlled-release niacin in dyslipoproteinemic veterans. Ann Intern Med 1994;121:252?8.

    230. Rader JI, Calvert RJ, Hathcock JN. Hepatic toxicity of unmodified and time-release preparations of niacin. Am J Med 1992;92:77?81 [Review].

    231. Knopp RH. Niacin and hepatic failure. Ann Intern Med 1989;111:769 [letter].

    232. Goldberg A, Alagona P Jr, Capuzzi DM, et al. Multiple-dose efficacy and safety of an extended-release form of niacin in the management of hyperlipidemia. Am J Cardiol 2000;85:1100?5.

    233. Garg R, Malinow M, Pettinger M, Upson B, Hunninghake D. Niacin treatment increases plasma homocyst(e)ine levels. Am Heart J 1999;138:1082?7.

    234. Brown WV. Niacin for lipid disorders. Postgrad Med 1995;98:185?93 [review].

    235. Guyton JR. Effect of niacin on atherosclerotic cardiovascular disease. Am J Cardiol 1998;82(12A):18U?23U [review].

    236. Welsh AL, Ede M. Inositol hexanicotinate for improved nicotinic acid therapy. Int Record Med 1961;174:9?15.

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